Pulse Clomipramine for Depressed Adolescents

TO THE EDITOR: Dr. Sallee and his colleagues (1) concluded that “the rate of response to pulse clomipramine was robust.” However, it is difficult to accept their conclusion. Indeed, when responders were defined by a decrease of 50% or more from baseline in Hamilton depression scale scores, there were seven responders to clomipramine and three responders to the placebo, and this difference did not reach statistical significance. Moreover, this difference should be paralleled with the rate of prior treatment in the two groups: three of the clomipramine-treated patients versus seven of the placebo-treated patients had received previous treatment. Therefore, the higher rate of treatment-resistant depression in the placebo group might account for the difference between the two groups in rates of responders. This hypothesis seems to be confirmed by the low response rate to a subsequent open-label treatment with various selective serotonin reuptake inhibitors (SSRIs) among placebo-treated patients.